Spinal orthosis to inhibit kyphosis and to minimize disk disease

ABSTRACT

In one embodiment, a spinal orthosis includes a left shoulder portion and a right shoulder portion connected to a retracting device through a retractable connector. The retractable connector is connected, at a first end, to the left shoulder portion and the right shoulder portion and is connected at a second end to the retracting device. The retractable connector is configured to pull the left shoulder portion and the right shoulder portion so as to move the shoulders of a patient in a rearward direction. The retractable connector is further configured to release the left shoulder portion and the right shoulder portion, thereby allowing the shoulders of the patient to return to a relaxed position.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/652,630, filed Jan. 5, 2010, which is a continuation of U.S. patentapplication Ser. No. 11/271,490, filed Nov. 10, 2005, issued as U.S.Pat. No. 7,654,972 on Feb. 2, 2010, which claims priority under 35U.S.C. §119(e) of U.S. Provisional Application No. 60/627,389, filedNov. 12, 2004 for “SPINAL BRACE TO INHIBIT KYPHOSIS AND TO MINIMIZE DISKDISEASE.” The disclosures of the above-referenced prior applications,publications, and patents are considered part of the disclosure of thisapplication, and are incorporated by reference herein.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to the field of orthotics. Morespecifically it relates to an orthosis applied to the spine to helpprevent progressive kyphosis.

2. Description of the Related Art

As one of skill in the art of orthopedic spine surgery, or orthopedics,will recognize, patients, especially older patients in their late 60s,70s, 80s and older, may have developed painful progressive kyphosis, andhave become dependent on assistive devices for ambulation such as, forexample, a cane, Canadian crutches, a walker or a wheelchair. Many ofthese patients have developed this deformity from a myriad of differentconditions, some of which are: poor posture, compression fracturessecondary to osteoporosis or other metabolic bone diseases (e.g.,osteomalacia, traumatic burst fractures or compression fractures),iatrogenic topping off phenomenon (in which adjacent cephalad segmentsto a fusion have developed, and collapsed into kyphosis), ligamentinjuries leading to instability and progressive kyphosis, anddegenerative disk disease leading to thoracolumbar kyphoscoliosis and/orflat back syndrome, etc. It is the job of an orthopedic spine surgeon tobecome aware of this condition and try to intervene. Such methods ofintervention have included: a reminder by the spouse or friend toimprove posture, intervention with physical therapy for posturalstrengthening exercises, intermittent brace immobilization, (e.g., aJewett orthosis, a TLSO (thoracolumbar spinal orthosis), a Cashorthosis, or lumbosacral corsets, etc), involvement in work out classes(e.g., weight lifting, yoga, Pilates, tae chi, marshal arts, etc.), butall of these act only as temporary measures. The kyphosis usuallycontinues to occur leading to increased deformity, difficulty ambulatingand the need many times for an assistive device and use of medicationsand/or surgery to correct the deformity.

Braces that have been used in the thoracolumbar sacral region tend to becumbersome and may not be worn for long periods of time because of poorpatient compliance and failure of the brace to maintain or prevent theprogression of the kyphotic deformity. If the braces are worn 24 hours aday, seven days a week, this would lead to an inevitable atrophy of theparaspinous musculature, and increase susceptibility to fracture due tothe loss in nutrition to the spine and vertebral column because of thedegree of immobilization. Rigid braces, such as the TLSO, could lead toatrophy also of the thoracic cavity which could result in diminishedrespiratory tidal volume, as well as decrease tone of the abdominalmusculature and thoracolumbar musculature, as well as decreasing thethoracic and lumbar bone density which could lead to compressionfractures, which could lead to back pain and/or instability.

As well as being used for treating the elderly, braces may also be usedto accommodate young populations that may be at risk. Young people maybe at risk due to, e.g., carrying heavy books to school, as well as forrapidly developing young women who have developed a postural kyphosis tominimize their enlargement of their breasts, or in the male populationin which the thin or esthetic young male who is not physically developedand has poor posture, can use this orthosis to improve their sagittalspinal contour.

It is estimated by some that 80% of the about 285 million people in theUnited States may injure their backs at some point in time necessitatingthem seeing a physician. It is the premise of some medical professionalsthat most disk disease and back pain may occur at a very early age frompoor end plate nutrition to the disk, as well as from weakenedparaspinous musculature and/or poor posture from and early age, e.g,from preteen all the way up to an adult. After 40, especially in thefemale population, the incidence of osteoporosis starts to become asignificant factor, and this continues all the way up into the elderly.This is manifested also with a failure in the later population forexercising and performing good paraspinous muscle strengthening and thenatural degenerative process of aging of the disks which leads to lossin disk height, decrease in disk hydration and increase in annulartears, as well as protrusions from the nucleus pulposus, as well asligament instability leading to anterior listhesis, retrolisthesis,lateral listhesis or rotatory deformity.

As the population grows older, there is a loss in the disk space heightover several levels which may lead to several inches lost in height.Therefore, a person who is six feet tall at age twenty, by the time theyare eighty, could end up being five feet ten inches tall. The loss inheight of the lumbar spine and thoracic vertebrae may result in astructural change.

As obesity has approached an epidemic proportion in the United States,some statistics show about two-thirds of all Americans are officiallyoverweight, and among those that are overweight, about 50% are obese,and close to about 5% are morbidly obese. With the number of childrenbecoming more and more inactive due to, e.g., TV, computer and videogames and their access to junk food, this trend may continue to increasewith secondary medical conditions, such as hypertension, diabetes, heartdisease, which may continue to escalate costs for medical care. It isestimated at this point in time that approximately 117 billion dollars ayear is spent on obesity-linked illnesses.

As a person becomes older it is typically more difficult for them toengage in cardiovascular exercise and exercise for the spine if this issomething that the person has not started at an earlier age. Somepatients, especially the elderly, may find it difficult to do much morethan just walk. In some cases, the addition of one or two exercises inconjunction with the walking is not kept up after the patient hascompleted physical therapy.

Due to these trends, there is a need for an orthosis that may passivelyallow the spine and paraspinous muscles to work with little effort,thereby encouraging a patient to wear the orthosis so as to prevent poorposture, to prevent progressive kyphosis, to prevent juvenile round backsyndrome, to decrease back pain and to assure appropriate spinalintegrity as the patient ages.

SUMMARY OF THE INVENTION

A spinal orthosis used to prevent progressive thoracic kyphosis, preventvertebral compression fractures, decrease disk degeneration, increaseend plate blood flow, increase paraspinous muscle blood flow, andincrease paraspinous muscle and ligament strength. The device is wornwith pads anterior to the shoulder which are light weight, with a strapthat extends onto a lumbar or sacral belt which is capable of shorteningand lengthening to stimulate mild hyperextension of the thoracolumbarspine.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a view of one embodiment of a spinal orthosis.

FIG. 2 is a flow diagram illustrating certain steps in an embodiment ofa method for treating a patient.

DETAILED DESCRIPTION OF CERTAIN EMBODIMENTS

Aspects of the present invention will be described with respect toparticular embodiments and with reference to certain drawings but theinvention is not limited thereto but only by the claims. The drawingsdescribed are only illustrative and are non-limiting. In the drawings,the size of some of the elements may be exaggerated and not drawn onscale for illustrative purposes.

Furthermore, the terms first, second, third, and the like in thedescription and in the claims, are used for distinguishing betweensimilar elements and not necessarily for describing a sequential orchronological order. It is to be understood that the terms so used areinterchangeable under appropriate circumstances and that the embodimentsof the invention described herein are capable of operation in othersequences than described or illustrated herein.

Moreover, the terms top, bottom, over, under, and the like in thedescription and the claims are used for descriptive purposes and notnecessarily for describing relative positions. It is to be understoodthat the terms so used are interchangeable under appropriatecircumstances and that the embodiments of the invention described hereinare capable of operation in other orientations than described orillustrated herein.

An embodiment of the invention relates to an orthotic device, ororthosis, applied to a patients spine to help prevent progressivekyphosis. An orthosis may be considered to be any external orthopedicdevice that prevents or assists the movement of the spine and/or limbs.The orthosis is designed to allow for a rearward extension of theshoulders by contracting or retracting a connecting means which extendsfrom a shoulder portion to a lumbosacral belt. The retracting can occurwithin the belt by tightening the connecting means that connects theshoulder pad portion to the lumbosacral belt. In one embodiment, theretracting takes place at variable intervals, e.g., about tenrepetitions per hour, to stimulate the paraspinous musculature which mayindirectly stimulate blood flow to the vertebral end plates and to theparaspinous musculature. By retracting a pre-set amount the brace may becapable of generating a force of mild extension of the shoulders whichwould translate into decreasing thoracic kyphosis and possiblyincreasing lumbar or lordosis and improving posture.

In one embodiment, the spinal orthosis mechanism for timing contractionscomprises a timer with a retracting device that is built into the belt.The connecting cable attaches to the belt which then pulls the cablefrom both ends, right and left, which would uniformly contract and causethe shoulder to be pulled backwards, forcing the chest to come out, anddecreasing the thoracic kyphosis. Since the lumbosacral unit is fixedalong the pelvis, this would also slightly increase the lumbar lordosis.

In a preferred embodiment, the orthosis is worn temporarily therebypossibly enhancing spinal musculature, enhancing vertebral body density,improving thoracic kyphosis and lumbar lordosis and decreasing theprogression of degenerative disk disease by increasing blood flow to thecartilaginous end plates which feed the disks by a process known asimbibition.

The orthosis may come in sizes for adults and be light weight with abelt that can be worn that is quite inconspicuous. The orthosis may alsobe worn by elderly population with osteoporosis or post op spinal fusionto prevent kyphotic deformity. Because the orthosis is light weight andeasy to apply, and is inconspicuous with one's clothing, there will belittle reason for noncompliance, as opposed to the more traditionalheavy, cumbersome and conspicuous braces that are presently beingutilized.

In elderly patients, the natural degenerative process of aging of thedisks may lead to loss in disk height, decrease in disk hydration andincrease in annular tears, as well as protrusions from the nucleuspulposus, as well as ligament instability leading to anterior listhesis,retrolisthesis, lateral listhesis or rotatory deformity. Use of theorthosis may prevent progressive deformity. It may also provide forparaspinous muscle strengthening. Use of the orthosis may also stimulateblood flow to the end plates, the primary nutrition for the disk wouldthereby increase, and this may decrease the rate of disk degeneration.

FIG. 1 is a view of one embodiment of a spinal orthosis. In thisembodiment the spinal orthosis 100 includes a shoulder pad unit 105comprising a left shoulder portion 105 a and a right shoulder portion105 b, which may be applied over both shoulders of a patient. Theanterior portion of the pads provide for a comfortable support in thedeltopectoral region. A thin band 140 goes around the top of theclavicle and upper portion of the scapula, which is then linked in theback to connectors 115 a and 115 b that run along the spinous processes.The connectors 115 a and 115 b may be encased in a plastic tubing,referred to herein as a connector arm 135, that then gets attached to alumbosacral unit 110 (a belt in this embodiment). A retractableconnector 125 engages the connectors 115 a and 115 b in the spinalportion of the connector arm 135. The retractable connector 125 is thenattached to a retracting device 120. The connectors 115 a and 115 b, andthe retractable connector 125 may be guided through the connector arm135 by various guiding means 130 a through 130 e. The guiding means maybe pulleys, ratchets, or plastic or metal guides configured to allow theconnectors 115 a and 115 b and the retractable connector 125 totranslate around the corners in the connector arm channel and thelumbosacral unit 110.

The shoulder portions 105 a and 105 b may be secured to the patient'sshoulders by straps or by a pressure fit, depending on the embodiment.In another embodiment the shoulder pad unit 105 may comprise two straps(one for each shoulder) that go around the shoulders and attach at bothends of the two straps to the connectors 115 a and 115 b. In anotherembodiment, the shoulder portions 105 a and 105 b may be separate units(not joined across the neck area as in the embodiment shown in FIG. 1)that are held onto the shoulders by securing means such as, for example,straps that pass under the shoulders, e.g., at the armpits.

The shoulder portions 105 a and 105 b may come in multiple sizes suchas, e.g., small, medium and large, for individuals with different sizeand shape. In one embodiment, the anterior deltopectoral region of theshoulder will be the area that is used for pulling the shoulders back.The device may be predominantly kept off of the bony structures, such asthe clavicle, acromion or greater tuberosity of the humerus. By pullingon the more muscular fat pad of the deltopectoral region, the gentleretraction of the connectors 115 a and 115 b may not apply a painfulforce to those aforementioned regions.

In one embodiment, the connector arm 135 is a thin, flat belt or tubethat has two cables or wires running in it that gets attached to thelumbosacral unit 110. The retracting device 120 may then pull on theconnectors 115 a and 115 b through a series of guides (e.g., pulleys,guide posts or ratchets, as discussed above).

The embodiment shown in FIG. 1 includes a T-shaped connector arm 135. Inanother embodiment, the T-shaped connector arm may be replaced by asingle connector arm channel that simply parallels the spine and wherethe connectors 115 a and 115 b enter at the top of the channel (nearwhere the guides 130 b and 130 c are positioned in FIG. 1).

The connectors 115 a and 115 b may be any of several forms includingstraps, cables, wires, flexible tubing, wires, and others. The materialof the connectors 115 a and 115 b may be any material that is strongenough to withstand the tensile force of pulling back on the shoulders,such as plastic, cloth, metal, nylon and others. The thin band 140 maycomprise the same, similar or different materials and forms as theconnectors 115 a and 115 b. The retractable connector 125 may alsocomprise the same, similar or different materials and forms as theconnectors 115 a and 115 b.

The lumbosacral unit 110 may comprise a belt made of a light weightplastic, polyethylene, polypropylene, neoprene, metal, such as stainlesssteel, titanium, aluminum, or nylon as well as others that are known tothose of skill in the art. The belt serves as an anchoring point ofattachment for the retractable connector 125 and/or the connectors 115 aand 115 b that run down the back and connect to the lumbosacral unit 110to provide a fixed point that does not move substantially and isconnected in such a way that, preferably, the only part that is pullingis the retraction of the connectors 115 a and 115 b from the shoulderportion to the lumbosacral region. With the belt in place, very minimalvertical displacement may be seen, and during the times of retractionthe belt may be kept secure. During the other times the belt may beslightly loosened. The connection for the belt can be a simple buckle,seat belt clasp, or spring-loaded clasp.

In another embodiment, the lumbosacral unit 110 takes the form of thighcuffs instead of a belt The thigh cuffs may perform the same anchoringas the belt, but attached to the thighs. The retracting device 120 maybe positioned on either or both thigh cuffs or positioned in theconnector arm 135 structure.

In one embodiment, retracting device 120 comprises an electric motor(e.g., an electric motor powered by a battery pack) to provideretraction or shortening of the cable system (illustrated by the arrowsalong the connectors 115 a, 115 b and the retractable connector 125 inthe embodiment shown in FIG. 1) which then gives rise to a force beingapplied to the anterior portion of the shoulders, which then pulls theshoulders back and creates a reduction in thoracic kyphosis and anincrease in lumbar lordosis.

For every centimeter of shortening of the retractable connector 125,there is a correlated displacement of shoulder portions 105 a and 105 b.Increasing the amount of displacement will then increase the forceacross the anterior portion of the shoulder, which then pulls theshoulders back, decreasing the thoracic kyphosis and increasing lumberlordosis. This dynamic motion allows the spine to go through a work outwithout the individual having to initiate and perform the exercisehimself. This indirect passive movement of the shoulders into extensionis what will increase the paraspinous muscle strength, and theparaspinous blood flow, and thereby increase cartilaginous end platenutrition.

In one embodiment, the retracting device 120 includes a wheel, locatedon either the right or left side of the belt, that is turned, therebysimultaneously shortening the connectors 115 a and 115 b. This wheelturning may engage the retractable connector 125 which will pull on theconnectors 115 a and 115 b, or in another embodiment, the wheel mayengage the connectors 115 a and 115 b directly, thereby applying a forceto the anterior deltopectoral area to pull the shoulders backwards.

In one embodiment, the orthosis 100 includes a lumbar pad attached to itto increase the lumbar lordosis. In one embodiment, the lumbar pad isattached to the lumbosacral unit 110, or the connector arm 135. The padmay be attached with a hook and loop-type fastener, such as Velcro®, sothat it may be temporarily attached and then removed.

FIG. 2 shows a flow diagram illustrating certain steps in an embodimentof a method for treating a patient with, e.g., an orthosis as describedabove. The method 200 may be performed by the patient theirself, by atrained therapist, by a medical doctor, or by a person trusted by thepatient. The method 200 may be performed using an orthosis similar tothe embodiment shown in FIG. 1 or by any of several other embodiments oforthosis that may perform similar actions, as would be known to one ofskill in the art.

With reference to FIGS. 1 and 2, the method 200 starts by attaching ashoulder unit 105 to a patient's shoulders at step 210. The shoulderunit 105 comprises shoulder portions 105 a and 105 b that may be securedsuch that the shoulder portions 105 a and 105 b pull on the anteriorportion of the patients shoulders without significant slippage.Attaching means such as straps or a pressure fit may be used to attachthe shoulder portion 105 a and 105 b. Method 200 continues at step 220where an anchoring device, such as the lumbosacral belt 110, is securedto a lower body region of the patient so as to prevent substantialvertical motion of the anchoring device when the shoulder units arepulled in step 230. In one embodiment, the anchoring device comprisesthigh cuffs. The anchoring device contains a retracting device 120 suchas an electric motor or a manual crank. When the retracting device 120is actuated, the retracting device retracts connectors 115 a and 115 bwhich are attached to the left shoulder portion 105 a and the rightshoulder portion 105 b, respectively, thereby pulling on the shoulderunit at step 230. The pulling results in the shoulders being extendedrearward. After maintaining the shoulders in a retracted position, theretracting device 120 is released at step 240, thereby allowing theshoulders to return to their relaxed position (or a slightly retractedposition). Steps 230 and 240 may be repeated a number of times toincrease the paraspinous muscle strength, and the paraspinous bloodflow, and thereby increase cartilaginous end plate nutrition

In one embodiment the retraction step 230 and release step 240 may betimed such that, once the device is attached and secured, it contractsand releases for about 20 repetitions in one minute. This may repeatedevery hour, as long as the orthosis is connected. What this process doesis to force the spine gently into extension and relaxation, and thismovement is what stimulates the paraspinous muscles which therebyincreases the blood flow to that region which then stimulates the bloodflow to the cartilaginous end plates. The disk, as one of skill in theart is aware, is an avascular structure, which receives most of itsnutrition from the cartilaginous end plates by the process known asimbibition. This diffusion of the nutrients to the disk space issupported by the nutritional integrity of that cartilaginous end plate.The early forms of degeneration, including loss in hydration, annulartears, loss in disk height and loss in elasticity, may be due, at leastin part, to poor end plate blood flow and nutrition. It is therefore thepurpose of this spinal orthosis to increase that blood flow, therebyincreasing the nutrition to the disk, and as a result, decreasing therate of disk degeneration. The contractions of 20 to 30 repetitions overa minute may be enough to stimulate the paraspinous musculature forincreased blood flow. In one embodiment the retracting device 120maintains the shoulders in a retracted position of improved posture whenthe repetition of steps 230 and 240 is completed. The retracted positionbeing a position of decreased thoracic kyphosis and increased lumbarlordosis.

In one embodiment, method 200 may be controlled with an on/off switch.This on/off switch may have a built in potentiometer which will give outa reading of the amount of force being applied to the shoulders. Anoutput display connected to the potentiometer may comprise three areas,a green area, a yellow area and a red area. A gentle retraction and acorresponding force may read in the green area, a more significantretraction and the corresponding force may read in the yellow area, anda severe retraction and the corresponding force may read in the redregion. Again, these retractions may comprise about 20 to 30 repetitionsover a period of a minute, giving rise to a maneuver which one couldreproduce either standing or sitting, lying, pushing his chest forwardand throwing his shoulders back repeatedly. This motion, if practicedroutinely, by an individual, would increase blood flow to theparaspinous musculature. However, with the spinal orthosis of theinvention, this particular maneuver is being done in a more passive way.

In one embodiment, after steps 230 and 240 have been completed about 20to 30 times, there is a cut off switch in electrical communication withthe retracting device 120 so as to deactivate the method 200. The reasonfor this is so as not to over work the musculature or strain theparaspinous muscles. It may be recommended that initially during apatient's first few weeks, the device should be kept at a very lowsetting and as the muscles become stronger, a higher setting can beutilized. In another embodiment, the retracting device on/off timing isconfigured to be monitored by a processor to identify how long each daythe orthosis is being worn. The processor may store the timinginformation in a memory to be retrieved later.

In one embodiment, a spinal orthosis includes shoulder means forattaching to a right shoulder and a left shoulder of a body, first meansfor pulling back on the shoulder means when the first pulling means isretracted, the first pulling means being connected to the shoulder meansattached to the left shoulder and second means for pulling back on theshoulder means when the second pulling means is retracted, the secondpulling means being connected to the shoulder means attached to theright shoulder. The orthosis further includes means for retracting thefirst pulling means and the second pulling means, the retracting meansattached to the first pulling means and the second pulling means, andmeans for securing the retracting means, the retracting means beingattached to the securing means, the securing means being attached to thebody below a lower back area. With reference to FIG. 1, aspects of thisembodiment include where the shoulder means are shoulder pads such asthe shoulder portions 105 a and 105 b, where the first and secondpulling means are cables such as connectors 115 a and 115 b, where theretracting means is an electric motor such as retracting device 120, andwhere the securing means is a lumbrosacral belt such as lumbosacral unit110.

While the above detailed description has shown, described, and pointedout novel features of the invention as applied to various embodiments,it will be understood that various omissions, substitutions, and changesin the form and details of the device or process illustrated may be madeby those skilled in the art without departing from the spirit of theinvention. As will be recognized, the present invention may be embodiedwithin a form that does not provide all of the features and benefits setforth herein, as some features may be used or practiced separately fromothers.

What is claimed is:
 1. A spinal orthosis comprising a left shoulderportion and a right shoulder portion connected to a retracting devicethrough a retractable connector, the retractable connector beingconnected, at a first end, to the left shoulder portion and the rightshoulder portion and being connected at a second end to the retractingdevice, the retractable connector configured to pull the left shoulderportion and the right shoulder portion so as to move the shoulders of apatient in a rearward direction, the retractable connector furtherconfigured to release the left shoulder portion and the right shoulderportion, thereby allowing the shoulders of the patient to return to arelaxed position.
 2. The spinal orthosis of claim 1, wherein theretracting connector is configured to pull and release the left shoulderportion and the right shoulder portion repeatedly.
 3. The spinalorthosis of claim 1, wherein the retracting device is configured toretract the retractable connector to pull the left shoulder portion andthe right shoulder portion, and wherein the retracting device is furtherconfigured to release the retractable connector to release the leftshoulder portion and the right shoulder portion.
 4. The spinal orthosisof claim 3, wherein the retracting device is configured to retract andrelease the retractable connector about 20 to 30 times in one minute. 5.The spinal orthosis of claim 1, wherein the retracting device includesan electric motor.
 6. The spinal orthosis of claim 5, further comprisinga battery pack electrically connected to the electric motor.
 7. Thespinal orthosis of claim 5, further comprising: a timer; and a switch inelectrical communication with the timer and the electric motor, theswitch configured to enable the retracting device to retract and torelease alternately after a first time period has elapsed.
 8. The spinalorthosis of claim 7, wherein the switch is further configured to disablethe retracting device after the retracting device has been enabled for asecond time period.
 9. The spinal orthosis of claim 8, furthercomprising: a memory; and a processor in electrical communication withthe switch and the timer, the processor being configured to receivetiming data from the timer indicating when the switch enabled anddisabled the retracting device, and to store the timing data in thememory.
 10. The spinal orthosis of claim 1, further comprising a lumbarpad positioned so as to increase lumbar lardosis.
 11. The spinalorthosis of claim 1, further comprising: a battery pack; and apotentiometer in electrical connection with the battery pack, thepotentiometer configured to output a voltage indicating a tensile forceof the retractable connector.
 12. The spinal orthosis of claim 1,further comprising an anchoring device connected to the left shoulderportion and the right shoulder portion through the retractableconnector.
 13. The spinal orthosis of claim 12, wherein the anchoringdevice comprises a belt adapted to be attached to the patient below alower back area.
 14. The spinal orthosis of claim 12, further comprisinga connector arm attached to the anchoring device at a first end of theconnector arm and providing a channel for the retractable connector. 15.The spinal orthosis of claim 12, further comprising a connector armcomprising a first arm portion with a proximal end of the first armportion attached to the anchoring device, the connector arm furthercomprising a second arm portion attached to a distal end of the firstarm portion and extending toward the left shoulder portion, and theconnector arm further comprising a third arm portion attached to thedistal end of the first arm portion and extending toward the rightshoulder portion.